United States Government Accountability Office
GAO
Report to Congressional Requesters
February 2005
BIOTERRORISM
Information on
Jurisdictions’
Expenditure and
Reported Obligation
of Program Funds
GAO-05-239
February 2005
BIOTERRORISM
Accountability Integrity Reliability
Highlights
Highlights of GAO-05-239, a report to
congressional requesters
Information on Jurisdictions’ Expenditure
and Reported Obligation of Program
Funds
Why GAO Did This Study
What GAO Found
In 1999, the Department of Health
and Human Services’ (HHS)
Centers for Disease Control and
Prevention (CDC) began funding
jurisdictions’ efforts to prepare for
bioterrorism attacks through the
Public Health Preparedness and
Response for Bioterrorism
program. After the events of
September 11, 2001, and the 2001
anthrax incidents, program funds
increased almost twentyfold. Citing
jurisdictions’ unexpended program
funds, HHS reallocated some fiscal
year 2004 funds to support other
local and national bioterrorism
initiatives. Jurisdictions and
associations representing
jurisdictions disputed HHS’s
assertion that large amounts of
funds remain unused, noting that
HHS did not acknowledge
obligated funds that had not yet
been expended.
Jurisdictions have expended a substantial amount of Bioterrorism program
funds. As of August 30, 2004, jurisdictions had expended over four-fifths of
the fiscal year 2002 funds awarded during the third budget period through
the HHS P accounts—the public assistance accounts that track over 90
percent of all funds awarded. As of that date, they had expended slightly
over half of P account funds awarded for the program’s fourth budget
period. Jurisdictions continued, as authorized, to expend funds beyond the
budget period for which they were awarded. For example, some
expenditures, such as contract payments, extend beyond one budget period.
GAO was asked to provide
information on (1) the extent to
which jurisdictions had expended
the fiscal year 2002 funds awarded
for the program’s third budget
period as of August 30, 2003, and
August 31, 2004, and the fiscal year
2003 funds awarded for the
program’s fourth budget period, as
of August 30, 2004; (2) the extent to
which fiscal year 2001, 2002, and
2003 funds awarded for the third
and fourth budget periods
remained unobligated as of August
30, 2004; and (3) factors
jurisdictions identified as
contributing to delays in expending
and obligating funds and actions
some jurisdictions took to address
them.
At the end of the program’s third budget period, jurisdictions reported that
less than one-sixth of all bioterrorism funds awarded for that period—
including both fiscal year 2001 and 2002 funds—remained unobligated, and
some jurisdictions reported that none of their funds remained unobligated.
As of August 1, 2004, jurisdictions estimated that less than one-quarter of all
funds awarded for the fourth budget period would remain unobligated as of
August 30, 2004, and five jurisdictions estimated that they would have no
funds remaining unobligated.
Many jurisdictions reported facing challenges, partly related to
administrative processes, that delayed their obligation and expenditure of
bioterrorism funds. These included workforce issues such as hiring freezes;
contracting and procurement processes to ensure responsible use of public
funds; and lengthy information technology upgrades. Some jurisdictions
have simplified these processes to expedite the obligation and expenditure
of funds.
We provided a draft of this report to HHS for comment, and the agency
informed us it had no comments on the draft report.
Expenditure Rates of the Third Budget Period’s Fiscal Year 2002 Bioterrorism Program
Funds from P Accounts, by Jurisdiction, as of August 30, 2003, and August 30, 2004
www.gao.gov/cgi-bin/getrpt?GAO-05-239.
To view the full product, including the scope
and methodology, click on the link above.
For more information, contact Marjorie Kanof
at (202) 512-7114.
Note: These data do not include all funds awarded to jurisdictions through the Bioterrorism program.
For example, while the program’s third budget period was a 24-month period, extending from
August 31, 2001, to August 30, 2003, and used funds from both fiscal years 2001 and 2002, these
expenditure rates reflect data only on fiscal year 2002 funds.
United States Government Accountability Office
Contents
Letter
1
Results in Brief
Background
Jurisdictions Have Expended over Four-Fifths of Fiscal Year 2002
Funds and over Half of Fiscal Year 2003 Funds
Few Bioterrorism Funds Remained Unobligated, According to
Jurisdiction Reports
Jurisdictions Identified Administrative Processes and Other
Challenges to Obligation and Expenditure, and Some
Jurisdictions Described Solutions
Concluding Observations
Agency Comments
14
19
20
Appendix I
Scope and Methodology
21
Appendix II
Bioterrorism Program’s Budget Period Three
Expenditures
26
Bioterrorism Program’s Budget Period Four
Expenditures
28
Unobligated Bioterrorism Program Funds Reported
by Jurisdictions
30
GAO Contact and Staff Acknowledgments
33
GAO Contact
Acknowledgments
33
33
Appendix III
Appendix IV
Appendix V
Related GAO Products
5
6
8
11
34
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GAO-05-239 Jurisdiction Bioterrorism Funding
Tables
Table 1: Bioterrorism Program Budget Periods
Table 2: Funds Included in Sources of Bioterrorism Expenditure
and Obligation Data
Table 3: Public Health Preparedness and Response for
Bioterrorism Program’s Budget Period Three Fiscal Year
2002 Funds Expended from P Accounts, by Jurisdiction, as
of August 30, 2003, and August 30, 2004
Table 4: Public Health Preparedness and Response for
Bioterrorism Program’s Budget Period Four Funds
Expended from P Accounts, by Jurisdiction, as of
August 30, 2004
Table 5: Unobligated Public Health Preparedness and Response for
Bioterrorism Program Funds Reported by Jurisdictions, as
of the End of Each Budget Period
7
23
26
28
30
Figures
Figure 1: Expenditure Rates of the Third Budget Period’s Fiscal
Year 2002 Bioterrorism Program Funds from P Accounts,
by Jurisdiction, as of August 30, 2003, and August 30, 2004
Figure 2: Expenditure Rates of the Fourth Budget Period’s Fiscal
Year 2003 Bioterrorism Program Funds from P Accounts,
by Jurisdiction, as of August 30, 2004
Figure 3: Unobligated Third and Fourth Budget Period
Bioterrorism Funds Reported by Jurisdictions
(percentage)
Page ii
9
11
13
GAO-05-239 Jurisdiction Bioterrorism Funding
Abbreviations
CDC
DPM
FMO
FSR
G accounts
HHS
NCA
P accounts
PGO
PMS
RFP
Centers for Disease Control and Prevention
Division of Payment Management
Financial Management Office
financial status report
general accounts
Department of Health and Human Services
Notice of Cooperative Agreement
public assistance accounts
Procurement and Grants Office
Payment Management System
request for proposals
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GAO-05-239 Jurisdiction Bioterrorism Funding
United States Government Accountability Office
Washington, DC 20548
February 28, 2005
The Honorable Joseph I. Lieberman
Ranking Minority Member
Committee on Homeland Security and Governmental Affairs
United States Senate
The Honorable Edward M. Kennedy
Ranking Minority Member
Committee on Health, Education, Labor, and Pensions
United States Senate
In 1999, the Department of Health and Human Services’ (HHS) Centers for
Disease Control and Prevention (CDC) began funding state and municipal
efforts to prepare for bioterrorism attacks through the Public Health
Preparedness and Response for Bioterrorism program. Total funding
awarded through the program ranged from about $40 million in 1999 to
about $50 million in 2001 annually. The events of September 11, 2001,
increased concern about bioterrorism. In addition, the anthrax incidents
during the fall of 2001 strained the public health system, including
surveillance1 and laboratory workforce capacities, at the state and
municipal levels.2 Following these incidents, program funding increased
almost twentyfold,3 and this increased level of funding continued in fiscal
years 2003 and 2004.4
With the substantial increase in funding after the terrorist attacks in 2001,
CDC modified the program’s budget periods.5 The program’s budget
1
Public health surveillance uses systems that provide for the ongoing collection, analysis,
and dissemination of health-related data to identify, prevent, and control disease.
2
See U.S. GAO, Bioterrorism: Public Health Response to Anthrax Incidents of 2001,
GAO-04-152 (Washington, D.C.: Oct. 15, 2003).
3
In February 2002, CDC awarded $918 million through the Bioterrorism program. An
additional $100 million was later awarded to support smallpox vaccination programs.
4
Throughout this report, the term fiscal year refers to the federal fiscal year, which is from
October 1 through September 30. In fiscal year 2003, $870 million was awarded to states,
selected municipalities, and territories. Approximately $844 million was awarded to states,
selected municipalities, and territories in fiscal year 2004.
5
Throughout this report, the term “budget period” is used to describe each of the five
periods for which funds were awarded within the multiyear program period.
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GAO-05-239 Jurisdiction Bioterrorism Funding
periods typically run from August 31 of one year to August 30 of the
next—a 12-month period—and use funds from the fiscal year under way at
the start of the period. However, the third budget period, which was
already under way at the time of the September 11 attack, was extended to
24 months, running from August 31, 2001, to August 30, 2003. It used funds
from both fiscal years 2001 and 2002. The fourth budget period reverted to
a 12-month period, running from August 31, 2003, to August 30, 2004, and
used funds from fiscal year 2003.
In May 2004, HHS reported that large unexpended balances remained of
the fiscal year 2002 and 2003 funds awarded to jurisdictions for the
program’s third and fourth budget periods.6 Citing these large unexpended
balances, HHS made the decision to reallocate approximately $55 million
of the funds for the fifth budget period (August 31, 2004, to August 30,
2005) to support other local and national bioterrorism initiatives.7 States
and national associations representing jurisdictions have disputed HHS’s
assertion that large amounts of funds remain unused, noting that HHS
chose to focus only on expenditures, and did not focus on obligated funds,
which are funds that a jurisdiction has legally committed to spend—for
example, through a contract for services—but has not yet expended.8
You asked us to provide information on the expenditure and obligation of
funds awarded under the Public Health Preparedness and Response for
Bioterrorism program cooperative agreements and factors that may affect
these expenditures and obligations.9 In this report, we will provide
6
Throughout this report, the term “jurisdictions” refers to the 50 states, the District of
Columbia, and the three funded municipalities—New York City, Chicago, and Los Angeles
County. The Bioterrorism program also awards funds to the territories of American Samoa,
Guam, and the U.S. Virgin Islands; the commonwealths of the Northern Mariana Islands
and Puerto Rico; the Federated States of Micronesia; and the republics of Palau and the
Marshall Islands. These awardees were outside the scope of our work.
7
These initiatives included the Cities Readiness Initiative, which funded 21 cities to help
develop their capacity to deliver medicines and medical supplies in case of a public health
emergency. In addition, funds were used to expand the capacity of CDC’s quarantine
stations and to support the BioSense surveillance program, an already existing program to
detect emerging diseases by collecting data from national, regional, and local data sources
such as hospital systems, ambulatory care sites, and pharmacy chains.
8
Obligated funds do not include future planned activities unless those activities are actually
contracted for. Expended funds refer to funds the jurisdiction has issued as checks,
disbursements of cash, or electronic transfers to liquidate an obligation.
9
A cooperative agreement is a mechanism used to provide financial support when
substantial interaction is expected between a federal agency and a state, local government,
or other recipient carrying out the funded activity.
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GAO-05-239 Jurisdiction Bioterrorism Funding
information on (1) the extent to which jurisdictions expended the fiscal
year 2002 funds awarded for the program’s third budget period as of
August 30, 2003, and August 30, 2004, and fiscal year 2003 funds awarded
for the program’s fourth budget period, as of August 30, 2004; (2) the
extent to which fiscal year 2001, 2002, and 2003 funds awarded for the
third and fourth budget periods remained unobligated by jurisdictions as
of August 30, 2004; and (3) factors that jurisdictions identified as
contributing to delays in expending and obligating funds and actions some
jurisdictions took to address those factors.
To determine the expenditure of fiscal year 2002 funds awarded during the
third budget period as of August 30, 2003, and August 30, 2004, and the
fourth budget period’s expenditures as of August 30, 2004, we analyzed
expenditure data obtained from HHS’s Division of Payment Management
(DPM) Payment Management System (PMS).10 These expenditure data
come from PMS’s public assistance accounts (P accounts)—awardee
accounts that are specific to particular cooperative agreements, such as
the Bioterrorism program, or grants. The Bioterrorism P accounts do not
include fiscal year 2001 funds awarded during the first half of the third
budget period. Therefore, we were not able to include fiscal year 2001
funds in our analysis of the third budget period’s expenditures. In addition,
the P accounts do not include funds carried over, with CDC’s approval,
from prior budget periods, funds related to the Strategic National
Stockpile awarded after fiscal year 2002,11 or funds provided to
jurisdictions as direct assistance.12 However, while the P accounts are a
subset of the total Bioterrorism funds awarded to jurisdictions, they
10
DPM is a division within HHS that provides grant payment, cash management, and grant
accounting support services to HHS and other federal departments and agencies. PMS is a
DPM-operated centralized payment system designed to expedite and manage the flow of
cash for grants and cooperative agreements from federal agencies to awardees and to
provide information on the disbursement of funds to the awarding agency.
11
The Strategic National Stockpile is a repository of pharmaceuticals and medical supplies
that can be delivered to the site of a biological or other attack. Responsibility for activities
related to the stockpile had been CDC’s in prior years, but, in March 2003, this
responsibility was transferred to the Department of Homeland Security. However, CDC
entered into a reimbursable agreement with the Department of Homeland Security so that
the Strategic National Stockpile funds were included in the Bioterrorism awards CDC made
to jurisdictions in fiscal year 2003.
12
Direct assistance refers to assistance jurisdictions ask CDC to provide in the form of
equipment, training, staff, or other services, rather than as funds, referred to as financial
assistance. We did not include direct assistance in our analysis.
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GAO-05-239 Jurisdiction Bioterrorism Funding
accounted for over 90 percent of program funds awarded.13 We determined
the percentage of both the third budget period’s fiscal year 2002 and fourth
budget period’s fiscal year 2003 funds expended by comparing
expenditures recorded in the PMS P accounts to the total funds in the
P accounts. We did not conduct a review to determine the appropriateness
of any jurisdiction’s expenditures.
To obtain obligation data, we reviewed the financial status reports (FSR)
that CDC required jurisdictions to submit at the end of the third budget
period (August 31, 2001, to August 30, 2003) and the estimated FSRs for
the fourth budget period (August 31, 2003, to August 30, 2004) that CDC
asked jurisdictions to submit by August 1, 2004. We also reviewed the
Notices of Cooperative Agreement (NCA), which are provided by CDC to
jurisdictions and contain information on the total bioterrorism funds
awarded to the jurisdiction for a budget period. Unlike PMS’s P account
data, the FSRs and NCAs include information on all bioterrorism funds
awarded as financial assistance, including both fiscal year 2001 and 2002
funds, funds carried over from prior periods, and funds related to the
Strategic National Stockpile.14 Because the FSR data related to obligation
are self-reported by jurisdictions, we interviewed officials from CDC,
HHS’s Office of the Inspector General (OIG), and jurisdiction audit
agencies to obtain information on any efforts to determine the reliability of
these data. Based on the work of the OIG and jurisdiction audit agencies,
obligation data for the third budget period from 18 jurisdictions and for
the fourth budget period from 1 jurisdiction can be considered reliable. In
other cases, the information presented is as reported by jurisdictions, and
we cannot attest to its reliability.
To describe factors that jurisdictions said contributed to delays in
obligating and expending funds and actions some jurisdictions took to
address those factors, we selected 19 jurisdictions, taking into account
diversity in geographic location, population size, urban and rural status,
and their expenditure and obligation patterns. We e-mailed these
jurisdictions to gather information on why some may have had
13
The funds in the P accounts make up approximately 92 percent of bioterrorism funds
awarded to jurisdictions for the third budget period—August 31, 2001, to August 30, 2003—
and approximately 93 percent of funds awarded for the fourth budget period—August 31,
2003, to August 30, 2004. When funds carried over from prior periods are included, the P
accounts make up 91 percent of all funds awarded during the third budget period and
85 percent of all funds awarded during the fourth budget period.
14
While the NCAs include funds awarded as direct assistance, the FSRs do not.
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GAO-05-239 Jurisdiction Bioterrorism Funding
unobligated or unexpended funds, and we obtained any necessary
clarification of responses by telephone or e-mail.15
We did our work from July 2004 through February 2005 in accordance
with generally accepted government auditing standards. (See app. I for
additional details on our scope and methodology.)
Results in Brief
Jurisdictions have expended a substantial amount of Public Health
Preparedness and Response for Bioterrorism program funds. As of August
30, 2004, they had expended over four-fifths of the fiscal year 2002 funds
awarded through the HHS P accounts during the third budget period
(August 31, 2001, to August 30, 2003). (The P accounts make up over
90 percent of all Bioterrorism program funds.) As of August 30, 2004,
jurisdictions had also expended slightly over half of the funds in the P
accounts awarded for the program’s fourth budget period (August 31,
2003, to August 30, 2004). As allowed by the CDC cooperative agreement,
jurisdictions have continued to expend funds beyond the budget period in
which they were awarded. Some expenditures, such as contract payments,
take place over a period of time; therefore, it may take jurisdictions longer
than one budget period to expend awarded funds.
At the end of the Bioterrorism program’s third budget period, jurisdictions
reported to CDC that less than one-sixth of all fiscal year 2001 and 2002
bioterrorism funds awarded for that period remained unobligated, and
some jurisdictions reported that no funds remained unobligated. As of
August 1, 2004, jurisdictions estimated that less than one-quarter of funds
awarded for the fourth budget period would remain unobligated as of
August 30, 2004, and five jurisdictions estimated that no funds would
remain unobligated.
Many jurisdictions reported facing challenges, partly related to state and
local administrative processes, that slowed their obligation and
expenditure of bioterrorism funds. These challenges included workforce
issues such as hiring freezes and difficulty recruiting qualified staff;
contracting and procurement processes to ensure the prudent use of
public funds; and lengthy information technology upgrades. Some
15
We contacted the following jurisdictions: Alaska, Chicago, Connecticut, Delaware,
Georgia, Kansas, Los Angeles County, Louisiana, Maryland, Massachusetts, Michigan,
Minnesota, Missouri, New Mexico, New York City, North Dakota, Rhode Island, Tennessee,
and Texas.
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GAO-05-239 Jurisdiction Bioterrorism Funding
jurisdictions found ways to simplify administrative processes to expedite
the obligation and expenditure of funds.
In assessing the pace at which jurisdictions are expending Bioterrorism
funds, it is useful to consider that responsible use of public funds requires
careful and often time-consuming planning before funds are obligated and
expended. In addition, it is important to recognize that some expenditures
take place over a period of time, which also can affect the speed at which
jurisdictions expend funds.
We provided a draft of this report to HHS for comment, and the agency
informed us that it had no comments on the draft report.
Background
The Bioterrorism cooperative agreement program spans five budget
periods and is scheduled to end August 30, 2005. Under this program, CDC
has made funds available through cooperative agreements with all
50 states, the District of Columbia, and three of the country’s largest
municipalities—New York City, Chicago, and Los Angeles County. CDC
has distributed funds to these jurisdictions using a formula under which
each jurisdiction receives a base amount of $5 million, plus additional
funds based on the jurisdiction’s population.16 The program’s budget
periods typically run from August 31 of one year to August 30 of the next,
although the third budget period was extended to run from August 31,
2001, to August 30, 2003. (See table 1 for more information on the budget
periods discussed in this report.) Under its cooperative agreement, a
jurisdiction is required to obligate funds before the end of the specified
budget period and expend funds before the end of the 12 months following
that period. However, CDC may give a jurisdiction permission to obligate
or expend funds beyond those time frames.
16
For the program’s fifth budget period, the base amount provided to most jurisdictions was
decreased to $3.9 million, and funds from the program were redirected to other
bioterrorism efforts. Jurisdictions that received larger amounts during the fifth budget
period included the District of Columbia, which continued to receive a base amount of
$10 million, and New York City, Chicago, and Los Angeles County, which continued to
receive base amounts of $5 million.
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GAO-05-239 Jurisdiction Bioterrorism Funding
Table 1: Bioterrorism Program Budget Periods
Budget period 3
Budget period 4
Budget period 5
Budget period
calendar dates
8/31/01 to 8/30/03
8/31/03 to 8/30/04
8/31/04 to 8/30/05
Federal fiscal year
funds used for each
budget period
Fiscal year 2001 and
fiscal year 2002
Fiscal year 2003
Fiscal year 2004
Source: GAO analysis of HHS documents.
Note: The federal fiscal year runs from October 1 through September 30. For example, federal fiscal
year 2002 ran from October 1, 2001, through September 30, 2002.
CDC’s Procurement and Grants Office (PGO) is responsible for awarding
and administering CDC’s grants and cooperative agreements. In this
capacity, PGO is responsible for notifying the jurisdictions, through an
NCA, of the funds awarded for each budget period. In addition to notifying
the jurisdictions, PGO also provides this information to CDC’s Financial
Management Office (FMO), which processes CDC’s grant awards and
cooperative agreements. FMO works with DPM to place the cooperative
agreement funds into the appropriate accounts and to ensure that
jurisdictions have access to their Bioterrorism funds through PMS’s
accounts. CDC’s Office of Terrorism Preparedness and Emergency
Response, which coordinates emergency response and preparedness
across CDC, is responsible for the programmatic components of the
program and also works with PGO and FMO to provide direct assistance
to jurisdictions on request. To monitor the use of the Bioterrorism funds,
CDC requires that jurisdictions submit regular progress reports that track
their progress toward completing a set of activities.17 Jurisdictions are also
required to submit annual FSRs that provide information on the
expenditure and obligation of Bioterrorism funds. In addition, DPM
monitors the funds drawn down by jurisdictions from PMS, and
jurisdictions must submit quarterly federal cash transaction reports to
DPM.
17
Jurisdictions are required to conduct activities in the following areas: preparedness
planning and readiness assessment, surveillance and epidemiology, laboratories,
communications and information technology, risk communication and health information
dissemination, and education and training.
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GAO-05-239 Jurisdiction Bioterrorism Funding
Jurisdictions Have
Expended over FourFifths of Fiscal Year
2002 Funds and over
Half of Fiscal Year
2003 Funds
Jurisdictions had expended a substantial amount of fiscal year 2002 and
2003 program funds as of August 30, 2004. They had expended over fourfifths of the fiscal year 2002 funds awarded through the HHS P accounts
for the program’s third budget period and over half of the fourth budget
period funds awarded through the HHS P accounts. As allowed by CDC’s
cooperative agreements, jurisdictions continued to expend fiscal year 2002
funds after the end of the third budget period in August 2003 and have
continued to expend funds awarded during the fourth budget period since
the end of that period.
Over 80 Percent of 2002
Bioterrorism Funds Were
Expended over the Course
of the Third and Fourth
Budget Periods
As of August 30, 2004, jurisdictions had expended 85 percent of the fiscal
year 2002 funds awarded through the PMS P accounts for the Bioterrorism
program’s third budget period.18 There was considerable variation among
jurisdictions’ expenditure rates, with individual jurisdictions’ rates ranging
from a high of 100 percent to a low of 27 percent. Ten jurisdictions had
expended all fiscal year 2002 funds in the P accounts, and 22 had
expended over 90 percent. Three jurisdictions, Delaware, the District of
Columbia, and Massachusetts, had expended less than half of their funds.
(See fig. 1 for information on the third budget period’s fiscal year 2002
funds expended as of August 30, 2004. App. II provides additional data.)
Jurisdictions continued, as authorized, to expend the third budget period’s
fiscal year 2002 P account funds over the course of the following budget
period to pay for obligations incurred during the third budget period, such
as contracts that extended beyond August 2003. Although jurisdictions had
expended only 56 percent of the third budget period’s fiscal year 2002 P
account funds by the end of that budget period, they had expended
85 percent of the funds as of August 30, 2004, the end of the fourth budget
period. No jurisdiction had expended all its fiscal year 2002 P account
funds by the end of the third budget period—individual expenditure rates
ranged from 4 percent to 87 percent. (See fig. 1 for information on the
third budget period’s fiscal year 2002 funds expended from the P accounts
as of August 30, 2003. App. II provides additional data.)
18
The fiscal year 2002 funds in the P accounts make up 92 percent of funds awarded to
jurisdictions during the Bioterrorism program’s third budget period—August 31, 2001, to
August 30, 2003. When funds carried over from periods prior to August 31, 2001, are
included, the P accounts make up 91 percent of all funds awarded to jurisdictions for that
period.
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GAO-05-239 Jurisdiction Bioterrorism Funding
Figure 1: Expenditure Rates of the Third Budget Period’s Fiscal Year 2002 Bioterrorism Program Funds from P Accounts, by
Jurisdiction, as of August 30, 2003, and August 30, 2004
Note: Data from the PMS P accounts do not include all funds awarded to jurisdictions through the
Bioterrorism program. For example, while the program’s third budget period was a 24-month period,
extending from August 31, 2001, to August 30, 2003, and using funds from both fiscal year 2001 and
fiscal year 2002, these expenditure rates reflect only fiscal year 2002 funds. In addition, the P
accounts do not include funds for the Strategic National Stockpile awarded after fiscal year 2002,
funds carried over from budget periods prior to the third budget period, or funds provided to
jurisdictions as direct assistance.
Over Half of 2003
Bioterrorism Funds Were
Expended over the Course
of the Fourth Budget
Period
As of August 30, 2004—the end of the fourth budget period—jurisdictions
had expended 53 percent of the fiscal year 2003 bioterrorism funds
awarded through the P accounts for that period.19 As with fiscal year 2002
funds awarded during the third budget period, there is variation in
individual jurisdictions’ rates of expenditure, which ranged from 93
percent to zero. While expenditure rates varied, 15 jurisdictions had
19
The fiscal year 2003 funds in the P accounts make up 93 percent of funds awarded to
jurisdictions during the Bioterrorism program’s fourth budget period—August 31, 2003, to
August 30, 2004. When funds carried over from periods prior to August 31, 2003, are
included, the P accounts make up 85 percent of all funds awarded to jurisdictions for that
period.
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GAO-05-239 Jurisdiction Bioterrorism Funding
expended at least two-thirds of the 2003 funds awarded through the P
accounts for the fourth budget period. (See fig. 2 for information on the
fourth budget period’s funds expended from the P accounts. App. III
provides additional data.) While slightly over half of the fourth budget
period’s funds in the P accounts had been expended as of August 30, 2004,
jurisdictions have continued to expend these funds during the current
budget period—August 31, 2004, to August 30, 2005. The pattern of
expenditure for budget period four funds was similar to that of budget
period three; in both cases, jurisdictions expended just over half their
funds during the budget period and continued to expend the funds during
the next budget period.
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Figure 2: Expenditure Rates of the Fourth Budget Period’s Fiscal Year 2003
Bioterrorism Program Funds from P Accounts, by Jurisdiction, as of
August 30, 2004
Fiscal year 2003 expenditures as of August 30, 2004
Jurisdictions as of
August 30, 2004
0-25% of P account funds expended
2
26%-50% of P account funds expended
20
51%-75% of P account funds expended
29
76%-100% of P account funds expended
3
Source: GAO analysis of HHS's Division of Payment Services Payment Management System data.
Note: The program’s fourth budget period was a 12-month period, extending from August 31, 2003, to
August 30, 2004, and using fiscal year 2003 funds. However, data in the PMS P accounts do not
include all funds awarded to the jurisdictions through the Bioterrorism program. For example, the P
accounts do not include funds for the Strategic National Stockpile awarded after fiscal year 2002 or
funds carried over from budget periods prior to the emergency supplemental appropriation issued in
fiscal year 2002. In addition, the PMS P accounts do not include funds provided to jurisdictions as
direct assistance.
Few Bioterrorism
Funds Remained
Unobligated,
According to
Jurisdiction Reports
At the end of the Bioterrorism program’s third budget period, jurisdictions
reported that less than one-sixth of fiscal year 2001 and 2002 funds
awarded for that period remained unobligated. Similarly, as of August 1,
2004, jurisdictions estimated that approximately one-fifth of fiscal year
2003 funds awarded for the program’s fourth budget period would remain
unobligated as of August 30, 2004, the end of that period.
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GAO-05-239 Jurisdiction Bioterrorism Funding
Jurisdiction Reports
Indicate That Less Than
One-Sixth of Third Budget
Period Funds Remained
Unobligated
According to the jurisdictions’ annual FSRs and NCAs, as of the end of the
third budget period (August 31, 2001, to August 30, 2003),20 14 percent of
all bioterrorism funds awarded for that period remained unobligated.21 As
with expenditure rates, individual jurisdictions’ rates of unobligated funds
varied, ranging from none to over three-fifths of the awarded funds. Seven
jurisdictions reported that all their funds from that period had been
obligated, and 44 jurisdictions reported that less than one-quarter of their
third budget period funds remained unobligated. Two jurisdictions, the
District of Columbia and Massachusetts, reported the highest levels of
unobligated third budget period funds—62 percent and 51 percent,
respectively. (See fig. 3 for more information on jurisdiction-reported
unobligated Bioterrorism funds. App. IV provides additional data.)
20
Jurisdictions are required to submit final FSRs no more than 90 days after the end of the
budget period—November 30. However, many jurisdictions continued to submit final FSRs
after that point. CDC uses the FSRs to collect annual data on unobligated funds from all
jurisdictions. However, while CDC reviews the obligation data, it has not taken steps to
verify the data’s reliability, and many jurisdictions also do not verify the reliability of
obligation data.
21
This does not include funds awarded as direct assistance, but does include funds awarded
in fiscal years 2001 and 2002, funds carried over from previous years, and funds related to
the Strategic National Stockpile. With approval from CDC, jurisdictions can carry forward
funds that were not obligated during the budget period for use during the next budget
period. Data from New York City were not comparable to those from other jurisdictions.
Because of this, the jurisdiction was excluded from our budget period three obligations
analysis, which we conducted using data from the remaining 53 jurisdictions.
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GAO-05-239 Jurisdiction Bioterrorism Funding
Figure 3: Unobligated Third and Fourth Budget Period Bioterrorism Funds Reported by Jurisdictions (percentage)
Note: The total funding awarded includes all funding provided to jurisdictions as financial assistance
through the cooperative agreement, including funds related to the Strategic National Stockpile and all
funds carried over from prior fiscal years. These data do not include funds provided as direct
assistance.
a
The program’s third budget period was a 24-month period, extending from August 31, 2001, to
August 30, 2003, and encompassing both fiscal year 2001 and fiscal year 2002 funds. Data on
unobligated balances for this period are based on the FSRs submitted after the end of the budget
period.
b
The program’s fourth budget period was a 12-month period, extending from August 31, 2003, to
August 30, 2004, and using fiscal year 2003 funds. Data on unobligated balances for this period are
based on the estimated FSRs submitted prior to the end of the budget period.
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GAO-05-239 Jurisdiction Bioterrorism Funding
Jurisdiction Estimates
Indicated That One-Fifth of
Fourth Budget Period
Funds Remained
Unobligated
According to jurisdiction estimates as of August 1, 2004, approximately
20 percent of all Bioterrorism funds awarded for the program’s fourth
budget period (August 31, 2003, to August 30, 2004) would remain
unobligated as of August 30, 2004.22 Jurisdictions’ individual estimated
unobligated balances varied greatly, ranging from none to almost threequarters of the awarded funds. Five jurisdictions estimated that all their
fourth budget period’s funds would be obligated by the end of the period,
and 31 jurisdictions estimated that less than one-quarter of their fourth
budget period’s funds would remain unobligated. Three jurisdictions,
Chicago, New Mexico, and Delaware, estimated that over half of the
Bioterrorism funds awarded to them for the fourth budget period would
remain unobligated as of August 30, 2004. (See fig. 3 for more information
on jurisdiction-reported unobligated Bioterrorism funds. App. IV provides
additional data.)
Jurisdictions
Identified
Administrative
Processes and Other
Challenges to
Obligation and
Expenditure, and
Some Jurisdictions
Described Solutions
Many jurisdictions faced challenges, partly related to state and local
administrative processes, that slowed the pace of their obligation and
expenditure of bioterrorism funds. Reported challenges included
workforce issues, contracting and procurement processes to ensure the
prudent use of public funds, and problems stemming from lengthy
information technology upgrades. Some jurisdictions have developed ways
to streamline these administrative processes, facilitating the obligation
and expenditure of funds.
22
This does not include funds awarded as direct assistance, but does include fiscal year
2003 funds, as well as funds carried over from previous years and funds related to the
Strategic National Stockpile. In early August 2004, jurisdictions provided CDC with an
estimate of what their unobligated fourth budget period funds would be as of August 30,
2004, the end of the budget period. Jurisdictions were not required to provide these
estimates if they did not anticipate requesting that funds remaining unobligated as of
August 30 be carried forward into the next budget period. Eight jurisdictions did not submit
estimated FSRs: Alaska, Los Angeles County, Illinois, Kansas, Maine, Maryland, Nebraska,
and Washington. In addition, data comparable to other jurisdictions were not available for
New York City. These jurisdictions were excluded from our budget period four obligation
analysis, which we conducted using data from the remaining 45 jurisdictions.
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GAO-05-239 Jurisdiction Bioterrorism Funding
Jurisdictions Reported
Challenges to Obligation
and Expenditure
State and municipal officials told us that the obligation and expenditure of
funds were delayed during the Bioterrorism program’s third and fourth
budget periods for a variety of reasons, including issues related to the
workforce, contracting and procurement, and information technology
upgrades.
Workforce
Officials in 16 of 19 jurisdictions we contacted cited workforce issues
related to recruitment and retention and complex staffing processes as
challenges to timely obligation and expenditure of bioterrorism funds.
According to the Association of State and Territorial Health Officials, 75 to
80 percent of bioterrorism funds have been used for personnel
expenditures.
Seven jurisdiction officials we contacted reported difficulties in recruiting
staff, and some officials reported staff retention problems. As we
previously reported,23 such barriers included noncompetitive salaries and a
general shortage of people with the necessary skills. Officials told us they
had difficulty finding qualified workers, particularly epidemiologists and
laboratory technicians, and two officials indicated that problems related to
recruiting have delayed the expenditure of funds. In one of those
jurisdictions, the public health laboratory had so many vacancies that
there were not enough staff to fully implement a new bioterrorism and
emergency preparedness initiative. Officials indicated that, within their
jurisdictions, skilled workers could find better-paying positions with other
organizations. In one case, a municipality had to persuade a job candidate
to take a significant pay cut to work on the program. In another instance,
the salaries offered by a federal agency within a state were about
25 percent higher than those offered by the state. The same state reported
that competition from the private sector and other agencies has resulted
not only in a shortage of qualified applicants for positions, but also in the
loss of highly qualified personnel who had gained extensive experience
and expertise working for the state.
Hiring freezes and complex staffing processes were also cited as delaying
the obligation and expenditure of funds. According to jurisdiction officials
with whom we spoke, as well as officials from the National Association of
County and City Health Officials, program officials in some jurisdictions
23
See Bioterrorism: Preparedness Varied across State and Local Jurisdictions
(GAO-03-373, Apr. 7, 2003), and HHS Bioterrorism Preparedness Programs: States
Reported Progress but Fell Short of Program Goals for 2002 (GAO-04-360R, Feb. 10, 2004).
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GAO-05-239 Jurisdiction Bioterrorism Funding
were not permitted to hire staff during an across-the-board freeze,
regardless of the federal funding available. Moreover, jurisdiction officials
reported that in some cases the release of a hiring freeze inundated the
hiring process, lengthening it in one state to as long as 10 months.
Jurisdiction officials stated that other staffing constraints also hindered
their hiring process. One state mandated mass layoffs in December 2002,
which resulted in the loss of approximately 60 health agency employees,
including the entire unit that was handling bioterrorism contracts. This
was followed in early 2003 by an early retirement plan that resulted in the
loss of support staff for the cooperative agreement. The layoffs and early
retirement program delayed bioterrorism contract payments. Moreover,
employees who had been laid off had contractual rights to placement in
new positions, which resulted in the placement into bioterrorism program
positions of some employees with little or no background in public health.
Some fiscal support positions remained unfilled for several months as a
result of the layoffs and early retirement program, which in turn affected
the state’s ability to process bioterrorism program payments.
Contracting and Procurement
Because expenditures related to contracting for services and procuring
equipment can occur after the end of a given budget period, program
officials stressed the importance of being able to expend obligated funds
up to 12 months beyond the budget period, as CDC allows for in this
program. To illustrate the importance of such an allowance, one official
gave the example of a contract for $100,000 that began in June 2003,
during the third budget period. Under the terms of the contract, the
contractor would bill the program quarterly. The state in question would
draw down funds for the contract from PMS on a quarterly basis.24 If the
program received the first bill of $25,000 in September 2003, the first
drawdown related to this contract would occur in December 2003 and
subsequent drawdowns would occur in March 2004, June 2004, and
September 2004, all within the next budget period.
Jurisdiction officials provided a number of examples of the complexity of
their jurisdictions’ contracting processes and the resulting effect on
obligations and expenditures.25 An official in one state reported that the
24
The schedule for drawing down funds is determined by each jurisdiction and varies
across jurisdictions. For example, another jurisdiction draws funds on a weekly basis.
25
Issues related to lengthy contracting and procurement requirements are not limited to this
cooperative agreement. For more information on other domestic preparedness activities
affected, see U.S. GAO, Emergency Preparedness: Federal Funds for First Responders,
GAO-04-788T (Washington, D.C.: May 13, 2004).
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GAO-05-239 Jurisdiction Bioterrorism Funding
state had to negotiate and develop contracts with over 100 local health
agencies after it received an influx of funding during the Bioterrorism
program’s third budget period. After the local health contracts were
developed, they needed approval by the municipalities or health district
boards, a process that in some cases took several months. Another state
indicated that its contracting process takes a minimum of 2 months. Yet
another stated that the process could take from 3 to 6 months, depending
on which complexities arise. In addition, officials reported that the request
for proposals (RFP) process and bidding requirements delayed their ability
to create contracts and orders for services and equipment. In one state, the
RFP process takes 4 to 7 months, while in another the process can take as
long as 9 months.
The necessity of developing large infrastructure projects related to the
bioterrorism preparedness cooperative agreement has also had an effect
on obligations and expenditures in a number of jurisdictions. These
projects, such as setting up a syndromic surveillance26 system, require the
assistance and expertise of a limited number of national contractors. A
state official informed us that since many of the jurisdictions began these
projects at the same time—after the influx of fiscal year 2002 funds during
the third budget period—some jurisdictions have had to wait for these
contractors to become available. Therefore, some jurisdictions have had to
wait to receive services and equipment, in effect delaying both obligations
and expenditures. In addition, jurisdictions indicated that effective
planning or the development of RFPs for these large projects required
extended periods of time. One official told us the state health department
went through a careful planning process in order to ensure the proper use
of funds, consequently delaying the obligation and expenditure of funds.
Information Technology
Upgrades
Several jurisdictions reported that their efforts to upgrade their
information technology—a focus area of the Bioterrorism program—
delayed program expenditures. Officials in four jurisdictions noted that it
took time to plan and implement improvements in information technology
26
The term “syndromic surveillance” applies to surveillance using health-related data that
precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant
further public health response. For example, in 1993, Milwaukee public health officials
discovered that the Cryptosporidium parasite, found in tainted water, had infected some
400,000 people, after they became aware that there were increased purchases of an
antidiarrheal agent from pharmacies. Public health officials are increasingly exploring the
utility of syndromic surveillance for detecting outbreaks associated with bioterrorism. See
U.S. GAO, Emerging Infectious Diseases: Review of State and Federal Disease
Surveillance Efforts, GAO-04-877 (Washington, D.C.: Sept. 30, 2004).
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GAO-05-239 Jurisdiction Bioterrorism Funding
systems and equipment. For example, in one state, the installation of each
piece of equipment, including new computer systems and
videoconferencing equipment, required a site survey by the state’s
Department of General Services to assess the feasibility of the proposed
location to house the equipment. These site surveys could take anywhere
from 2 to 12 months to complete.
In another state, an official reported that funds were designated to support
the state’s Internet connectivity to provide local public health agencies
and their public health partners with continuous, high-speed Internet
access. Because significant areas of the state did not have access to highspeed Internet services, the state conducted engineering studies, which
delayed distribution of funds to local public health agencies.
Some Jurisdictions Have
Streamlined
Administrative Processes
to Facilitate Obligation and
Expenditure of Funds
While officials described challenges to quickly obligating and expending
bioterrorism funds, some also described techniques they had developed to
address workforce and procurement issues. Officials in three jurisdictions
indicated that being exempted from hiring freezes expedited the obligation
of funds. In one case the jurisdiction exempted bioterrorism positions
from hiring freezes and also gave these positions the highest priority for
hiring. According to another state official, many of the program staff were
hired as contractual or “at will” employees, to bypass the state’s lengthy
hiring process. Another state, which was reluctant to hire permanent fulltime program staff because of concern about the sustainability of federal
funding,27 employed temporary staff instead.
Some officials also described techniques they had developed to address
challenges related to procurement issues. Prior to receiving fiscal year
2002 funds during the program’s third budget period, one jurisdiction’s
program elected to use a nonprofit fiscal and administrative intermediary
to reduce the delays caused by the municipality’s regulations. A program
official told us that using the intermediary also allowed the program to
expedite the routine processes of recruitment, contracting, purchasing,
and ensuring fiscal accountability. According to the official, the
intermediary has a long history of collaborating with that health agency to
quickly and successfully implement new initiatives and is experienced in
grant management. The official stated that the intermediary has reduced
the time that it takes to implement program procedures because it does
27
Our previous work has also reported this concern. See GAO-03-373.
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GAO-05-239 Jurisdiction Bioterrorism Funding
not have to follow the municipality’s normal requirements.28 For instance,
unlike the health agency, the intermediary is not subject to certain
municipal contracting and procurement requirements. Consequently, it is
able to use statewide general services contracts that can have as little as a
2-day turnaround. In addition, the intermediary has reduced the
municipality’s RFP process from the usual 6 months to 2 months.
One state official indicated that the state health agency had made a
concerted effort to streamline its procurement process. Prior to this effort,
the procurement process had taken as long as 18 months, including time
for the development and distribution of an RFP and for appeals. The
official said that one of the major improvements involved compiling a list
of preapproved contractors, which enables bioterrorism program officials
to purchase directly from those contractors without going through the
time-consuming RFP process.
Another official told us that the health agency staff can place orders and
contracts more rapidly than usual if they designate them as “sole source”
and “single source” procurement, meaning that the needed equipment or
service is available from only one vendor. The official indicated that the
state’s bioterrorism program uses this designation whenever they can
demonstrate that only one vendor can provide the equipment or service.
Additionally, the state has “master price” agreements with some vendors
for certain goods and services that are commonly needed by the various
agencies in the state. The official said that staff can quickly place orders
for goods and services that fall under the master price agreement and
receive these items in 2 to 4 days.
Concluding
Observations
After the terrorist events of 2001, HHS’s funding to help jurisdictions
prepare for and defend against a possible bioterrorism attack greatly
increased. In 2004, HHS expressed concern that jurisdictions had not
moved quickly enough to use these funds. However, jurisdictions
expended and obligated a substantial amount of program funds as of
August 30, 2004. In assessing the pace at which jurisdictions are spending
these funds, it is useful to consider that prudent use of public funds—
particularly for new programs—requires careful and often time-consuming
planning. Once plans have been developed, obligating and expending the
28
Officials in this municipality indicated that the intermediary follows all federal
regulations, but has the authority to bypass some municipal regulations.
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GAO-05-239 Jurisdiction Bioterrorism Funding
funds to implement them takes additional time. It is also important to
recognize that because some expenditures, such as those for contracts,
take place over a period of time rather than as one lump sum early in the
budget period, it may take longer than the program’s budget period to
expend these funds. Furthermore, jurisdictions face additional challenges
to quickly obligating and expending funds, partly related to various
administrative processes, although some jurisdictions have found ways to
streamline certain processes.
Agency Comments
We provided a draft of this report to HHS for comment, and the agency
informed us it had no comments on the draft report. However, HHS
provided technical comments, which we incorporated into the report as
appropriate.
As we arranged with your office, unless you publicly announce its
contents earlier, we plan no further distribution of this report until 30 days
after its issue date. At that time, we will send copies to the Secretary of
Health and Human Services, the Director of the Centers for Disease
Control and Prevention, appropriate congressional committees, and other
interested parties. We will also make copies available to others who are
interested upon request. In addition, the report will be available at no
charge on the GAO Web site at http://www.gao.gov.
If you or your staffs have any questions about this report, please call
Marjorie Kanof at (202) 512-7114. Major contributors to this report are
listed in appendix V.
Janet Heinrich
Director, Health Care—Public Health Issues
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Appendix I: Scope and Methodology
Appendix I: Scope and Methodology
For the Department of Health and Human Services (HHS) Centers for
Disease Control and Prevention’s (CDC) Public Health Preparedness and
Response for Bioterrorism program cooperative agreement, we provide
information on the extent to which jurisdictions had expended fiscal year
2002 funds awarded for the third budget period as of August 30, 2003, and
August 30, 2004, and had expended fiscal year 2003 funds awarded for the
fourth budget period as of August 30, 2004. We also provide information
on the extent to which fiscal year 2001, 2002, and 2003 Bioterrorism funds
awarded for the program’s third and fourth budget periods were obligated,
and challenges jurisdictions have faced when attempting to expend or
obligate the Bioterrorism funds. To provide information on the
expenditure and obligation of Bioterrorism program funds awarded to
jurisdictions, we analyzed documents and interviewed officials from HHS’s
Office of the Secretary, CDC, Division of Payment Management (DPM),
and Office of the Inspector General (OIG). In addition, we reviewed
documents and interviewed officials from the Association of State and
Territorial Health Officials and the National Association of County and
City Health Officials, two national associations representing state and
local health officials. We also interviewed jurisdiction audit and
Bioterrorism program officials to obtain information on program
obligations and to determine challenges faced by jurisdictions in
expending and obligating funds, and reviewed documents from the
Congressional Research Service, the Association of Public Health
Laboratories, and other organizations.
To determine expenditures as of August 30, 2003, and August 30, 2004, we
analyzed expenditure data from DPM’s Payment Management System
(PMS). We obtained and reviewed data from both the public assistance
(P) accounts and the general (G) accounts.1 Funds accounted for in the
P accounts are specific to certain grants or agreements, while G accounts
merge funds from grants and agreements made to one grantee into one
overall account. While over 90 percent of funds awarded to jurisdictions
through the Bioterrorism program are tracked in P accounts,2 some funds
1
All Bioterrorism program funds awarded are accounted for in one of these two accounts.
PMS data do not account for any funds provided to a jurisdiction as direct assistance and
we did not include direct assistance in our analysis.
2
The funds in the P accounts make up approximately 92 percent of bioterrorism funds
awarded to jurisdictions for the third budget period—August 31, 2001, to August 30, 2003—
and approximately 93 percent of funds awarded for the fourth budget period—August 31,
2003, to August 30, 2004. When funds carried over from prior periods are included, the
P accounts make up 91 percent of all funds awarded during the third budget period and
85 percent of all funds awarded during the fourth budget period.
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GAO-05-239 Jurisdiction Bioterrorism Funding
Appendix I: Scope and Methodology
are tracked in the G accounts, including all unexpended funds from budget
periods prior to the fiscal year 2002 funds awarded during the third budget
period and funds related to the Strategic National Stockpile before and
after fiscal year 2002.3 Because expenditures from the G accounts related
to a specific grant or agreement cannot be linked to funds from specific
budget periods, we are not able to describe the rates of expenditure of
Bioterrorism funds tracked in the G accounts. Moreover, because all funds
awarded to jurisdictions prior to the fiscal year 2002 funds are tracked in
the G accounts, we are not able to account for all expenditures during the
program’s third budget period—August 31, 2001, to August 30, 2003.
Rather, we are able to track expenditures for only the second portion of
that budget period, starting with the fiscal year 2002 emergency
supplemental appropriation.4 Expenditure data provided in this report
were obtained from PMS’s P accounts and include only funds awarded as
financial assistance beginning with the fiscal year 2002 emergency
supplemental appropriation.5 (See table 2 for information on funding
included in the data sources reviewed.) The OIG annually contracts for an
audit that provides reasonable assurance about the design of controls
included in DPM’s PMS, including controls for recording award
authorizations, processing awardee requests for funds, and reporting
payment and recipient disbursement information to the awarding agency.6
We did not conduct a review to determine the appropriateness of any
jurisdiction expenditure.
3
Prior to the fiscal year 2002 emergency supplemental appropriation, all funds for the
Bioterrorism program were tracked in G accounts. At CDC’s request, starting with the 2002
emergency supplemental appropriation, DPM placed almost all program funding into P
accounts in order to better track expenditures.
4
Department of Defense and Emergency Supplemental Appropriation for Recovery from
and Response to Terrorist Attacks on the United States Act, Pub. L.107-117, 115 Stat. 2230
(2002).
5
In 10 jurisdictions, funding provided for smallpox activities in May 2003 was credited to
the jurisdiction’s fiscal year 2003 period. In these cases, the funds should have been
credited to the fiscal year 2001/2002 period, and the P account data in this report reflect the
corrected funding levels. These jurisdictions were Arkansas, California, Connecticut,
Georgia, Los Angeles County, Maine, Minnesota, Ohio, Washington, and Wyoming.
6
See HHS OIG, Report on Department of Health and Human Services, Program Support
Center, Division of Payment Management’s Controls Placed in Operation and Tests of
Operating Effectiveness, A-17-03-000009 (Washington, D.C.: Oct. 6, 2003), and HHS, HHS
FY 2004 Performance and Accountability Report (Washington, D.C.: Dec. 13, 2004).
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Appendix I: Scope and Methodology
Table 2: Funds Included in Sources of Bioterrorism Expenditure and Obligation
Data
Bioterrorism
funds tracked
through the
PMS P accounts
Bioterrorism funds
tracked through
the notices of
cooperative
agreement
X
X
Fiscal year 2002 funds
X
X
X
Fiscal year 2003 funds
X
X
X
Funds carried forward
from budget periods prior
to fiscal year 2001
X
X
Funds carried forward
from fiscal year 2001a
X
X
X
X
Fiscal year 2001 funds
Strategic National
Stockpile funds
b
Bioterrorism
funds tracked
through the
financial status
reports
Source: GAO analysis of HHS documents.
Note: The Notice of Cooperative Agreement also includes data on funds awarded as direct
assistance. We did not include those funds in our analysis.
a
Data on funds carried forward from fiscal year 2001 are only included in the Notices of Cooperative
Agreement and the Financial Status Reports from the fourth budget period forward.
b
Fiscal year 2002 Strategic National Stockpile Funds are tracked through the P accounts.
To determine obligation data, we reviewed the financial status reports
(FSR) jurisdictions were required to submit to CDC at the end of the third
budget period (August 31, 2001, to August 30, 2003) and the estimated
FSRs for the fourth budget period (August 31, 2003, to August 30, 2004)
that jurisdictions were requested to submit by August 1, 2004. Unlike
PMS’s P account data, the FSRs include information on all Bioterrorism
funds awarded as financial assistance, including both fiscal year 2001 and
2002 funds awarded during the third budget period, funds carried over
from prior periods, and funds related to the Strategic National Stockpile.
Along with FSRs for the entire third budget period, CDC asked
jurisdictions to submit FSRs reflecting only the fiscal year 2002 emergency
supplemental appropriation funds. However, because few jurisdictions
submitted such emergency supplemental FSRs, we were unable to use
these FSRs. Because of this, we are reporting on obligation data obtained
from the FSRs for the entire third budget period, encompassing both fiscal
year 2001 and 2002 funds; this is a different period from that used for the
expenditure data provided in this report, which describe only
expenditures of the third budget period’s fiscal year 2002 funds. Final
FSRs for the fourth budget period were not available in sufficient time to
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Appendix I: Scope and Methodology
be used in our work. For this period, we used the estimated FSRs
jurisdictions were asked to submit prior to the end of the budget period.
While the unobligated amounts reported on the final FSR may vary from
the estimates, CDC determined that these estimates were sufficiently
accurate to use for planning purposes. Seven jurisdictions did not submit
an estimated FSR, but did provide information in their application for
budget period five funds on estimated unobligated balances as of August
30, 2004. Eight jurisdictions did not provide any information on estimated
unobligated balances and were excluded from our analysis.7
In addition to reviewing jurisdictions’ FSRs, we also reviewed the Notices
of Cooperative Agreement (NCA), which are provided by CDC to
jurisdictions and provide information on total Bioterrorism program funds
awarded to them for a budget period. Unlike the PMS P account data, the
NCAs include information on all funds awarded for the program’s entire
third budget period, including funds from both fiscal years 2001 and 2002,
and information on funds carried over from previous periods, funds
related to the Strategic National Stockpile, and funds awarded as direct
assistance.8 To determine obligation rates, we compared the information
on total funds awarded obtained from the NCAs and FSRs to obligation
data that jurisdictions reported in the third budget period FSRs and
estimated in the fourth budget period FSRs.
We interviewed CDC staff to resolve any inconsistencies between the
information provided on the FSRs and information provided in the NCAs
and modified data as appropriate. In addition, because the data related to
obligation are self-reported by jurisdictions to CDC, we interviewed
officials at CDC and HHS’s OIG to obtain information on any work done to
determine the reliability of these data. We also contacted the jurisdiction
audit agencies in all the jurisdictions by e-mail or telephone to determine
whether they had performed any work to determine the reliability of the
obligation data. Data for the third budget period from 18 jurisdictions and
for the fourth budget period from 1 jurisdiction can be considered reliable
7
These jurisdictions were Alaska, Illinois, Kansas, Los Angeles County, Maine, Maryland,
Nebraska, and Washington. In addition, data from New York City were not comparable to
those from other jurisdictions. Because of this, this jurisdiction was excluded from our
obligations analysis.
8
Because the NCAs include awarded funds not included in the P accounts, they could not
be used to describe expenditure rates for specific budget periods. In addition, we did not
include data on direct assistance in our analysis.
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GAO-05-239 Jurisdiction Bioterrorism Funding
Appendix I: Scope and Methodology
based on the work of OIG and jurisdiction audit agencies.9 However, in
many cases, insufficient work had been done to assess the reliability of the
obligation data reported by jurisdictions. In these cases, the information
presented is as reported by the jurisdictions, and we cannot attest to its
reliability. In addition, we did not conduct a review to determine the
appropriateness of any obligations reported by jurisdictions to CDC.
To describe factors that jurisdictions say contributed to delays in
obligating and expending funds and actions some jurisdictions took to
address those factors, we contacted selected jurisdictions via e-mail in two
phases. Initially, the team contacted 10 jurisdictions to gather information
on why they may have had unobligated Bioterrorism funds.10 We analyzed
the obligation and expenditure data to identify jurisdictions with high and
low rates of unobligated and unexpended Bioterrorism funds, for both the
third and fourth budget periods. Jurisdictions were categorized as those
with (1) reported high unobligated balances, (2) reported low unobligated
balances, or (3) reported low unobligated balances and high levels of
unexpended funds. We then selected jurisdictions from each of the groups,
taking into account diversity in geographic location, population size, urban
and rural status, and their expenditure and obligation patterns. We
e-mailed each jurisdiction, and we followed up by telephone to obtain any
necessary clarification on responses.
For phase 2, we e-mailed 3 jurisdictions from the phase 1 group and 9
additional jurisdictions. These 12 jurisdictions had expended from 50 to
87 percent of their third budget period funds by August 30, 2003, the end of
that period, but had expended 100 percent of those funds by August 30,
2004.11 We followed up by telephone and e-mail to obtain any necessary
clarification on responses.
9
OIG determined that the third budget period obligation data reported by Chicago, the
District of Columbia, Florida, Georgia, Illinois, Los Angeles County, Maryland,
Massachusetts, Michigan, New Jersey, New York, New York City, North Carolina, Ohio,
Pennsylvania, Texas, and Virginia were reliable. In addition, our interviews with
jurisdiction audit bodies identified work performed to determine the reliability of
Connecticut’s third and fourth budget period obligation data.
10
These jurisdictions were Chicago, Connecticut, Delaware, Georgia, Los Angeles County,
Maryland, Massachusetts, Michigan, New York City, and North Dakota.
11
These jurisdictions were Alaska, Kansas, Louisiana, Minnesota, Missouri, New Mexico,
Rhode Island, Tennessee, Texas, and three jurisdictions also included in the first e-mail
phase—Chicago, Maryland, and New York City.
Page 25
GAO-05-239 Jurisdiction Bioterrorism Funding
Appendix II: Bioterrorism Program’s Budget
Period Three Expenditures
Appendix II: Bioterrorism Program’s Budget
Period Three Expenditures
Table 3: Public Health Preparedness and Response for Bioterrorism Program’s Budget Period Three Fiscal Year 2002 Funds
Expended from P Accounts, by Jurisdiction, as of August 30, 2003, and August 30, 2004
Jurisdiction
P account funds
Percentage of P account
funds expended as of
August 30, 2003
Alabama
Percentage of P account
funds expended as of
August 30, 2004
$14,900,443
70
94
Alaska
6,350,514
61
100
Arizona
16,422,170
56
89
11,425,317
55
87
California
56,806,825
56
87
Colorado
14,475,766
62
89
Connecticut
10,366,586
56
85
Chicago
11,447,312
65
100
Delaware
6,744,505
30
50
District of Columbia
11,273,558
20
27
Florida
40,581,081
76
97
Georgia
24,045,179
26
86
Hawaii
7,546,593
57
89
Idaho
7,880,688
63
82
Illinoisa
26,101,381
63
86
Indiana
18,491,799
25
63
Iowa
11,110,544
62
98
Kansas
10,985,143
87
100
Kentucky
13,937,647
47
62
Los Angeles County
24,511,171
20
52
Louisiana
14,949,145
65
100
8,203,236
48
65
Maryland
16,791,405
56
100
Massachusetts
19,134,801
4
27
Michigan
27,125,655
64
89
Minnesota
16,525,446
82
97
Mississippi
11,332,975
54
59
Missouri
17,456,448
72
100
Montana
7,008,529
61
95
Nebraska
8,809,733
45
91
Nevada
9,448,659
49
86
New Hampshire
7,451,193
33
68
Arkansas
a
Maine
Page 26
GAO-05-239 Jurisdiction Bioterrorism Funding
Appendix II: Bioterrorism Program’s Budget
Period Three Expenditures
P account funds
Percentage of P account
funds expended as of
August 30, 2003
New Jersey
23,732,611
16
62
New Mexico
9,049,686
68
100
New Yorka
29,418,122
55
92
New York City
20,274,180
70
99
North Carolina
22,919,940
60
97
North Dakota
6,429,710
35
96
Ohio
30,803,150
67
78
Oklahoma
12,682,086
61
83
Oregon
12,616,956
48
76
Pennsylvania
32,340,936
56
81
Rhode Island
7,333,840
50
100
South Carolina
13,931,820
71
79
South Dakota
6,680,486
62
89
Jurisdiction
Percentage of P account
funds expended as of
August 30, 2004
Tennessee
16,581,744
72
100
Texas
51,421,771
56
100
Utah
9,447,160
59
99
Vermont
6,355,413
60
76
Virginia
20,758,682
61
82
Washington
20,190,120
56
87
8,980,655
76
86
Wisconsin
16,940,986
81
91
Wyoming
6,430,629
55
67
$894,962,130
56
85
West Virginia
Total
Source: GAO analysis of Department of Health and Human Services Division of Payment Services Payment Management System data.
Note: These data do not include all funds awarded to jurisdictions through the Bioterrorism program.
While the program’s third budget period was a 24-month period, extending from August 31, 2001, to
August 30, 2003, and using funds from both fiscal years 2001 and 2002, these expenditure data
reflect only fiscal year 2002 funds. In addition, the public assistance (P) accounts do not include funds
awarded for the Strategic National Stockpile awarded after fiscal year 2002. Those funds are tracked
in general (G) accounts, and cannot be tracked by a specific budget period. The
P accounts also do not include funds provided to jurisdictions as direct assistance.
a
Data on funds awarded to California, Illinois, and New York do not include funds awarded to
Los Angeles County, Chicago, or New York City.
Page 27
GAO-05-239 Jurisdiction Bioterrorism Funding
Appendix III: Bioterrorism Program’s Budget
Period Four Expenditures
Appendix III: Bioterrorism Program’s Budget
Period Four Expenditures
Table 4: Public Health Preparedness and Response for Bioterrorism Program’s
Budget Period Four Funds Expended from P Accounts, by Jurisdiction, as of
August 30, 2004
Jurisdiction
Alabama
P account funds
Percentage of P account
funds expended as of
August 30, 2004
$15,138,887
59
Alaska
6,041,857
75
Arizona
17,586,381
35
10,664,828
69
California
61,994,981
44
Chicago
11,378,246
37
Colorado
15,048,945
58
Connecticut
12,450,843
2
6,429,371
27
10,877,012
47
Florida
43,372,308
51
Georgia
23,655,673
0
Hawaii
7,450,193
70
Idaho
7,639,590
74
Arkansas
a
Delaware
District of Columbia
Illinois
a
27,855,766
67
Indiana
18,869,769
54
Iowa
11,493,758
44
Kansas
10,948,648
72
Kentucky
13,766,539
59
Los Angeles County
27,263,067
30
Louisiana
15,137,245
41
7,474,025
66
Maryland
17,314,106
64
Massachusetts
19,721,554
76
Michigan
28,981,577
79
Minnesota
15,788,416
93
Mississippi
11,322,442
59
Missouri
17,908,941
74
Montana
7,147,269
63
Nebraska
8,624,463
27
Nevada
9,490,029
55
Maine
Page 28
GAO-05-239 Jurisdiction Bioterrorism Funding
Appendix III: Bioterrorism Program’s Budget
Period Four Expenditures
Jurisdiction
New Hampshire
P account funds
Percentage of P account
funds expended as of
August 30, 2004
7,164,384
36
New Jersey
24,725,667
48
New Mexico
9,342,376
51
31,675,789
50
New York
a
New York City
23,024,362
71
North Carolina
24,002,282
44
North Dakota
6,257,186
49
Ohio
31,484,830
70
Oklahoma
13,228,697
41
Oregon
13,237,862
61
Pennsylvania
33,719,067
35
Rhode Island
7,305,761
44
14,174,122
65
South Carolina
South Dakota
6,338,591
43
Tennessee
18,175,779
59
Texas
55,225,049
44
Utah
9,914,452
70
Vermont
6,246,379
62
Virginia
22,068,328
66
Washington
16,389,229
59
8,811,416
65
17,361,226
60
5,839,684
48
$925,110,907
53
West Virginia
Wisconsin
Wyoming
Total
Source: GAO analysis of Department of Health and Human Services Division of Payment Services Payment Management System data.
Note: The program’s fourth budget period was a 12-month period, extending from August 31, 2003, to
August 30, 2004, using fiscal year 2003 funds. The Payment Management System’s public
assistance (P) accounts do not include funds for the Strategic National Stockpile awarded after fiscal
year 2002 or funds carried over from budget periods prior to the emergency supplemental
appropriation issued in February 2002. In addition, the P accounts do not include funds provided to
jurisdictions as direct assistance.
a
Funds awarded to California, Illinois, and New York do not include funds awarded to Los Angeles
County, Chicago, or New York City.
Page 29
GAO-05-239 Jurisdiction Bioterrorism Funding
Appendix IV: Unobligated Bioterrorism
Program Funds Reported by Jurisdictions
Appendix IV: Unobligated Bioterrorism
Program Funds Reported by Jurisdictions
Table 5: Unobligated Public Health Preparedness and Response for Bioterrorism Program Funds Reported by Jurisdictions,
as of the End of Each Budget Period
a
Budget period fourb
Budget period three
Jurisdiction
Percentage of awarded
funds reported
unobligated
Total award
Percentage of awarded
funds reported
unobligated
Total award
Alabamad
$16,559,338
7
$16,786,043
18
7,738,197
0
e
e
17,998,231
9
20,377,936
12
c
d
Alaska
Arizonaf
Arkansas
f
c
12,612,579
16
13,032,389
26
Californiag
62,166,027
14
70,101,613
47
Chicagod, h
12,627,939
4
11,977,908
59
16,531,912
11
17,896,688
5
11,864,756
18
14,196,592
17
f
Colorado
Connecticut
i
Delaware
8,054,596
41
9,881,459
74
District of Columbiaf, h
12,705,295
62
16,953,474
35
Floridah
43,649,932
2
46,997,742
2
26,817,366
33
34,365,094
38
h
Georgia
Hawaii
8,929,643
12
8,801,780
2
Idaho
8,515,356
17
9,366,998
12
Illinoisd, g, h
27,849,480
2
e
e
Indiana
19,243,012
25
26,971,704
0
11,823,150
5
12,726,247
16
12,384,717
0
e
e
14,025,286
35
18,169,281
12
e
f
Iowa
Kansas
Kentuckyd
h
Los Angeles County
25,726,260
3
e
Louisiana
16,811,200
5
17,009,305
36
8,894,028
37
e
e
Marylandd, h
18,607,520
0
e
e
Massachusettsh, j
22,124,540
51
32,377,306
23
Michigan
30,104,203
7
35,271,511
8
Minnesota
18,534,985
7
18,182,765
2
Mississippi
12,197,005
42
17,112,807
40
Missourif
19,060,349
1
19,160,450
3
Montana
8,292,560
10
7,380,744
16
9,526,033
3
e
e
10,886,894
16
10,953,790
30
Maine
d, h
Nebraska
Nevada
Page 30
GAO-05-239 Jurisdiction Bioterrorism Funding
Appendix IV: Unobligated Bioterrorism
Program Funds Reported by Jurisdictions
Budget period threea
Budget period fourb
Percentage of awarded
funds reported
unobligated
Total award
c
Jurisdiction
New Hampshire
Percentage of awarded
funds reported
unobligated
Total award
c
8,426,601
15
8,725,305
12
h
26,367,685
22
30,660,360
14
New Mexico
12,546,177
20
13,319,379
70
33,962,894
1
35,863,566
4
k
k
k
k
24,548,953
2
26,020,533
0
6,747,355
0
6,423,043
0
32,724,507
21
35,368,314
35
Oklahoma
13,322,159
17
16,248,592
14
Oregon
14,667,495
18
17,039,499
7
33,209,653
15
38,212,027
35
8,634,168
0
7,545,070
0
14,954,089
24
15,077,330
10
7,134,836
7
6,975,546
35
17,231,897
0
19,452,073
5
54,035,277
14
68,858,586
16
11,821,907
0
10,423,316
2
Vermont
7,704,711
20
7,973,690
32
Virginiad, h
24,026,543
19
29,313,295
0
e
New Jersey
New York
g, h
New York City
North Carolinah
North Dakota
h
Ohio
h
Pennsylvania
Rhode Island
South Carolina
f
South Dakota
Tennessee
Texas
h
Utah
Washington
22,116,478
11
e
West Virginia
10,316,254
17
10,007,010
5
Wisconsin
18,846,878
11
20,255,129
11
Wyoming
7,362,222
25
5,953,862
12
$987,149,159
14
$957,787,150
19
Total
Source: GAO analysis of jurisdiction Financial Status Reports (FSR) and annual program applications.
a
The program’s third budget period was a 24-month period, extending from August 31, 2001, to
August 30, 2003, and encompassing both fiscal year 2001 and 2002 funds. Obligation data for this
period are based on the FSR submitted after the end of the budget period.
b
The program’s fourth budget period was a 12-month period, extending from August 31, 2003, to
August 30, 2004, and encompassing fiscal year 2003 funds. Obligation data for this period are based
on the estimated FSR submitted prior to the end of the budget period.
c
Total funding awarded to jurisdictions as financial assistance through the cooperative agreement,
including all funds carried over from prior budget periods.
d
Data on awarded funds were not consistent between jurisdiction FSRs and the Notices of
Cooperative Agreement. Based on information provided by officials at the Centers for Disease
Control and Prevention, we determined the correct award amounts. In no case did the difference
account for more than 4 percent of the total awarded funds.
Page 31
GAO-05-239 Jurisdiction Bioterrorism Funding
Appendix IV: Unobligated Bioterrorism
Program Funds Reported by Jurisdictions
e
No data fiscal year 2003 data were available for these jurisdictions.
f
These jurisdictions did not submit estimated FSRs for the fourth budget period, but did provide
information in their application on estimated unobligated balances as of August 30, 2004.
g
Data on funds awarded to California, Illinois, and New York do not include funds awarded to Los
Angeles County, Chicago, and New York City.
h
Data for the third budget period have been determined to be reliable.
i
Data for the third and fourth budget period have been determined to be reliable.
j
Data on funds awarded to Massachusetts were not consistent between the jurisdiction FSR and the
Notice of Cooperative Agreement. The jurisdiction did not account for $6,682,740 carried over from
prior budget periods in its fourth budget period estimated FSR.
k
Data comparable to other jurisdictions were not available.
Page 32
GAO-05-239 Jurisdiction Bioterrorism Funding
Appendix V: GAO Contact and Staff
Acknowledgments
Appendix V: GAO Contact and Staff
Acknowledgments
GAO Contact
Marjorie Kanof, (202) 512-7114
Acknowledgments
In addition to the person named above, key contributors to this report
were Helene Toiv, Emily Gamble Gardiner, Lucia P. Fort, Roseanne Price,
and Jessica Cobert.
Page 33
GAO-05-239 Jurisdiction Bioterrorism Funding
Related GAO Products
Related GAO Products
HHS Bioterrorism Preparedness Programs: States Reported Progress but
Fell Short of Program Goals for 2002. GAO-04-350R. Washington, D.C.:
February 10, 2004.
Bioterrorism: Public Health Response to Anthrax Incidents of 2001.
GAO-04-152. Washington, D.C.: October 15, 2003.
Emerging Infectious Diseases: Review of State and Federal Disease
Surveillance Efforts. GAO-04-877. Washington, D.C.: September 30, 2004.
Emergency Preparedness: Federal Funds for First Responders. GAO-04788T. Washington, D.C.: May 13, 2004.
Bioterrorism: Preparedness Varied across State and Local Jurisdictions.
GAO-03-373. Washington, D.C.: April 7, 2003.
Bioterrorism: The Centers for Disease Control and Prevention’s Role in
Public Health Protection. GAO-02-235T. Washington, D.C.: November 15,
2001.
Bioterrorism: Review of Public Health Preparedness Programs. GAO-02149T. Washington, D.C.: October 10, 2001.
Bioterrorism: Public Health and Medical Preparedness. GAO-02-141T.
Washington, D.C.: October 9, 2001.
Bioterrorism: Coordination and Preparedness. GAO-02-129T.
Washington, D.C.: October 5, 2001.
Bioterrorism: Federal Research and Preparedness Activities. GAO-01915. Washington, D.C.: September 28, 2001.
Combating Terrorism: Observations on Biological Terrorism and Public
Health Initiatives. GAO/T-NSIAD-99-112. Washington, D.C.: March 16,
1999.
(290394)
Page 34
GAO-05-239 Jurisdiction Bioterrorism Funding
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